scholarly journals Determinants of length of stay:implications on differential funding for rural and metropolitan hospitals

2000 ◽  
Vol 23 (4) ◽  
pp. 126 ◽  
Author(s):  
Andy H Lee ◽  
Jim Codde
Keyword(s):  
Length Of Stay ◽  
State Government ◽  
Western Australia ◽  
Diagnosis Related Groups ◽  
Patient Discharge ◽  
Inpatient Stay ◽  
Discharge Data ◽  
Patient Transfers ◽  
Adjustment Strategy ◽  
Government Perspective

This study analysed and compared the determinants of length of inpatient stay between the rural and metropolitanpublic hospitals. The investigation was based on the 1998/99 Western Australia patient discharge data. A Coxregression model was used due to the high proportion of patient transfers in the rural hospitals. It was found thatseveral variables were associated with length of stay (LOS) variations within Diagnosis Related Groups (DRG). Themethod provides additional insights to hospital management and clinicians in assessing the risk of prolongedhospitalisation. From a state government perspective, a DRG payment adjustment strategy may be developed fordifferent categories of admitted patient episodes. The analysis has implications on the formulation of differentialfunding rates between rural and metropolitan hospitals.

Determining the Effects of Patient Casemix on Length of Hospital Stay: A Proportional Hazards Frailty Model Approach

2001 ◽  
Vol 40 (04) ◽  
pp. 288-292 ◽  
Author(s):  
K. K. W. Yau ◽  
A. H. Lee
Keyword(s):  
Proportional Hazards ◽  
Diagnosis Related Groups ◽  
Insurance Coverage ◽  
Length Of Hospital Stay ◽  
Patient Discharge ◽  
Frailty Model ◽  
Hospital Length ◽  
Hospital Length Of Stay ◽  
Discharge Data ◽  
Prolonged Hospitalization

Summary Objectives: To identify factors associated with hospital length of stay (LOS) and to model variations in LOS within Diagnosis Related Groups (DRGs). Methods: A proportional hazards frailty modelling approach is proposed that accounts for patient transfers and the inherent correlation of patients clustered within hospitals. The investigation is based on patient discharge data extracted for a group of obstetrical DRGs. Results: Application of the frailty approach has highlighted several significant factors after adjustment for patient casemix and random hospital effects. In particular, patients admitted for childbirth with private medical insurance coverage have higher risk of prolonged hospitalization compared to public patients. Conclusions: The determination of pertinent factors provides important information to hospital management and clinicians in assessing the risk of prolonged hospitalization. The analysis also enables the comparison of inter-hospital variations across adjacent DRGs.

scholarly journals Examining the relationship between poverty and length of stay: a repeated cross-sectional study of paediatric hospitalisations in Chile

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e034512
Author(s):  
Florencia Borrescio-Higa ◽  
Dominiquo Santistevan
Keyword(s):  
Length Of Stay ◽  
Fixed Effects ◽  
Patient Discharge ◽  
Cross Sectional Study ◽  
Poverty Rate ◽  
Sectional Study ◽  
Cross Sectional ◽  
Discharge Data ◽  
Individual Level ◽  
The Relationship

ObjectiveTo measure poverty-based disparities in inpatient length of stay for paediatric hospitalisations. In particular, this paper examines the relationship between municipality level poverty rates and length of stay, accounting for individual level characteristics.DesignWe use patient discharge data to conduct a repeated cross-sectional study of the totality of paediatric hospitalisations in 15 regions of Chile, in the years 2011, 2013, 2015 and 2017.SettingAll hospital discharges in 15 regions of Chile.Participants1 033 222 discharges for children under the age of 15, between 2011 and 2017.Outcome measuresLength of stay (LOS); LOS by type of insurance and type of hospital; hospitalisation rates; municipality-level average LOS.ResultsWe find that municipality level poverty rates are a significant predictor of LOS, even after controlling for individual and area level characteristics, including type of insurance. Children from municipalities in the poorest quintile have a LOS that is 14% shorter as compared with children from municipalities in the richest quintile. This relationship is stronger for publicly insured children: the decrease in LOS associated with the same poverty change is of 22%.ConclusionsThis paper shows that there is an association between municipality-level poverty rates and length of stay for paediatric hospitalisations in Chile. For the vast majority of the sample, and after controlling for individual level characteristics, an increase in the municipality level poverty rate is associated with a decrease in the length of stay. Further, there is a non-linearity in the relationship, where at the highest poverty rates, poverty and LOS are positively associated. These findings are robust after controlling for type of hospital (public vs private), type of insurance (public vs private), type of diagnosis, as well as year and region fixed effects.

scholarly journals Crohn’s disease: a population-based study of surgery in the age of biological therapy

2021 ◽  
Author(s):  
Christian Stöss ◽  
Maximilian Berlet ◽  
Stefan Reischl ◽  
Ulrich Nitsche ◽  
Marie-Christin Weber ◽  
...  
Keyword(s):  
Crohn’S Disease ◽  
Crohn's Disease ◽  
Minimally Invasive ◽  
Biological Therapy ◽  
Hospital Admissions ◽  
Diagnosis Related Groups ◽  
Age Distribution ◽  
Considerable Proportion ◽  
Discharge Data ◽  
Number Of Patients

Abstract Purpose Despite primary conservative therapy for Crohn’s disease, a considerable proportion of patients ultimately needs to undergo surgery. Presumably, due to the increased use of biologics, the number of surgeries might have decreased. This study aimed to delineate current case numbers and trends in surgery in the era of biological therapy for Crohn’s disease. Methods Nationwide standardized hospital discharge data (diagnosis-related groups statistics) from 2010 to 2017 were used. All patients who were admitted as inpatient Crohn’s disease cases in Germany were included. Time-related development of admission numbers, rate of surgery, morbidity, and mortality of inpatient Crohn’s disease cases were analyzed. Results A total number of 201,165 Crohn’s disease cases were included. Within the analyzed time period, the total number of hospital admissions increased by 10.6% (n = 23,301 vs. 26,069). While gender and age distribution remained comparable, patients with comorbidities such as stenosis formation (2010: 10.1%, 2017: 13.4%) or malnutrition (2010: 0.8%, 2017: 3.2%) were increasingly admitted. The total number of all analyzed operations for Crohn’s disease increased by 7.5% (2010: n = 1567; 2017: n = 1694). On average, 6.8 ± 0.2% of all inpatient patients received ileocolonic resections. Procedures have increasingly been performed minimally invasive (2010: n = 353; 2017: n = 687). The number of postoperative complications remained low. Conclusion Despite the development of novel immunotherapeutics, the number of patients requiring surgery for Crohn’s disease remains stable. Interestingly, patients have been increasingly hospitalized with stenosis and malnutrition. The trend towards more minimally invasive operations has not relevantly changed the rate of overall complications.

scholarly journals The Yannarie Solar Project: Design of a Solar Saltfield in Western Australia to Safeguard the Natural Environment

2013 ◽  
Vol 11 (1) ◽  
pp. 10-18
Keyword(s):  
Cultural Heritage ◽  
State Government ◽  
Western Australia ◽  
Migratory Bird ◽  
Large Area ◽  
Gulf Region ◽  
Marine Fauna ◽  
Solar Salt ◽  
Exmouth Gulf ◽  
Salt Industry

The Northwest Coast of Western Australia is the location for a number of large solar saltfields. More than 10 million tonnes of high grade solar salt is exported annually from these saltfields; predominantly servicing the chloralkali industries of Northern and Southeast Asia. Straits Resources Limited is a mining company with operations in Australia and Indonesia. It has identified the solar salt industry as an opportunity to diversify its resource portfolio and build a longer-term position within the resource sector. Access has been approved by the Government of Western Australia to a large area in the eastern Exmouth Gulf region of Western Australia suitable for a solar saltfield with an ultimate capacity as high as 10 million tonnes per annum. All new resources projects in Australia must proceed through a rigorous environmental approval process at both the Federal (Commonwealth) and State Government levels. Straits commissioned a team of saltfield design, environmental and engineering consultants to design an economically viable saltfield that minimises impacts to the environment. There has been a series of iterative changes in its design based on feedback from environmental and cultural heritage studies. This has enabled the saltfield to be specifically located within a defined footprint to avoid sensitive areas such as mangroves, tidal creeks and algal mats. Comprehensive studies have been undertaken on the local marine and terrestrial flora and fauna (including migratory bird and marine fauna), together with surveys for cultural heritage, soils, hydrology and a sweep of other parameters including hydrodynamic modelling of the marine environment. A commercial trawling fishing industry operates in the waters of Exmouth Gulf that is also the permanent home or on the migratory path of a number of significant marine fauna, including whales, turtles, and dugongs. The project, known as the Yannarie Solar Project, is progressing through the environmental approval processes of the Australian Commonwealth and Western Australian Governments. The conclusion is that the technical findings of the suite of studies that examined the environmental aspects of the engineering requirements of the saltfield provide a sound basis for project approval. Assuming that approval is given, and the current schedule maintained, construction would commence in 2008 and shipments of salt in 2011.

Abstract 164: Treatment Differences in Acute Stroke By Mode of Transport

2012 ◽  
Vol 5 (suppl_1) ◽  
Author(s):  
Prasanthi Govindarajan ◽  
Anisha Chandra ◽  
David Ghilarducci ◽  
Steve Shiboski ◽  
Barbara Grimes ◽  
...  
Keyword(s):  
Acute Stroke ◽  
Demographic Data ◽  
Patient Discharge ◽  
Cross Sectional Study ◽  
Primary Diagnosis ◽  
Cross Sectional ◽  
Discharge Data ◽  
Patient Demographic Data ◽  
Mode Of Transport ◽  
Time Of Admission

Background: EMS (Emergency Medical Services) is an important component of the stroke chain of survival. While in hospital stroke time targets have shown to be better when prehospital providers provide advance notification, population-wide studies on thrombolysis rates (IV t-PA) for those who arrive by EMS is sparse. Objective: To examine differences in treatment rates for acute stroke by mode of transport. Methods: This is a cross-sectional study of all patients who were transported to hospitals in two Northern California counties by providers of a single EMS agency during a three year period. Patient demographic data, prehospital provider clinical assessment was obtained from the computerized prehospital transport records and patient location, hospital demographics, physician diagnosis and treatment rates were obtained from statewide administrative patient discharge data. The data sources were linked using probabilistic linkage methodology. Patients ≥18 years of age with validated ICD- 9 code for stroke were included. We excluded inter-facility transports and direct admissions. Results: Of 10,456 patients who had a hospital based discharge diagnosis of stroke, 3787 (36%) were transported by EMS. Mean age at the time of admission was 75 years (+/- 14); 55% (2093) were females, 65% (2471) were whites and 86% (3247) were Hispanics. Most of the patients had Medicare (72%, 2737) and 92% (3471) were transported from home. Majority of the patients were treated at stroke centers [n=3014, (80%)]) and at community hospitals [n=3664, (97%)]. Of 3757 patients with a primary diagnosis of stroke, 4% (150) were treated with IV t-PA. After controlling for covariates, patients transported by EMS had higher odds of treatment with IV t-PA (OR 2.6, 95 CI 1.9-3.3). Treatment at stroke centers (OR 1.5, 95 CI 1-2.2) and academic centers were independently associated with treatment rates (OR 2.4, 95 CI 1.6-3.6). Conclusions: Arrival by EMS to emergency department is associated with higher treatment rates with thrombolytics for acute stroke patients and efforts should be targeted to improve use of EMS for stroke.

Goolarabooloo Futures: Mining and Aborigines in Northwest Australia

2018 ◽  
pp. 208-223
Author(s):  
Stephen Muecke
Keyword(s):  
State Government ◽  
Western Australia ◽  
Science And Technology ◽  
The State ◽  
Ethnographic Study ◽  
Mining Companies ◽  
The World ◽  
Multinational Mining Companies ◽  
Liquefied Gas ◽  
Northwest Australia

In our apparently postcolonial age, colonization is proceeding apace in Goolarabooloo country near Broome in Western Australia where sovereignty has never been ceded, and no treaty ratified. The colonial ‘settler’ economy was established in the late 19th century with the pearling and pastoral industries, but today it is multinational mining companies (‘extraction colonialism’) that are extending their reach with the urging of the State government and even some Aboriginal agencies. This ethnographic study describes two ‘worlds’: Those (the ‘Moderns’) who like to see themselves as ‘naturally’ extending the territory of a universalist modernity via their institutions of science and technology, governmental organisation, the law and the economy. Under scrutiny, this world turns out to be less robust institutionally and conceptually than it pretends to be; it operates with fantasies, blunders, poor planning, little negotiation and waste. Often it works, but in the instance of the four-year struggle between Woodside Energy and the Goolarabooloo, the latter was able to resist the former’s desire to build a liquefied gas plant on their traditional land. Woodside and its partners left with billions of dollars wasted in the effort. The ‘world’ of the Indigenous Goolarabooloo is the second group of institutions my extended ethnography will describe.

A State Government Perspective on Aussat

1990 ◽  
Vol 58 (1) ◽  
pp. 130-135
Author(s):  
Phil Skelton ◽  
Tony Dean
Keyword(s):  
State Government ◽  
Government Perspective

scholarly journals Factors associated with the length of hospital stay of women undergoing cesarean section

2019 ◽  
Vol 53 ◽  
pp. 65
Author(s):  
Samire Lopes Pereira ◽  
Thales Philipe Rodrigues da Silva ◽  
Alexandra Dias Moreira ◽  
Taiane Gonçalves Novaes ◽  
Milene Cristine Pessoa ◽  
...  
Keyword(s):  
Cesarean Section ◽  
Hospital Stay ◽  
Gestational Hypertension ◽  
Diagnosis Related Groups ◽  
Age Groups ◽  
Length Of Hospital Stay ◽  
Hypertensive Disorder ◽  
Age Group ◽  
Cross Sectional ◽  
Discharge Data

OBJECTIVE: To evaluate whether age group, complications or comorbidities are associated with the length of hospitalization of women undergoing cesarean section. METHODS: A cross-sectional study was carried out between June 2012 and July 2017, with 64,437 women undergoing cesarean section and who did not acquire conditions during their hospital stay. Hospital discharge data were collected from national health institutions, using the Diagnosis-Related Groups system (DRG Brasil). The DRG referring to cesarean section with additional complications or comorbidities (DRG 765) and cesarean section without complications or associated comorbidities (DRG 766) were included in the initial diagnosis. The influence of age group and comorbidities or complications present at admission on the length of hospital stay was assessed based on the means of the analysis of variance. The size of the effect was verified by Cohen’s D, which allows evaluating clinical relevance. The criticality levels were identified using the Duncan test. RESULTS: The longest length of hospital stay was observed in the age group from 15 to 17 years old and among those aged 45 years old or more. The hospital stay of women with complications or comorbidities at the time of admission was also longer. Moreover, it was noted that the increase in criticality level was associated with an increase in the mean length of hospital stay. CONCLUSIONS: The length of hospital stay of women is higher among those belonging to the age group ranging from 15 to 17 years old and for those aged 45 years old or more. The presence of associated comorbidities, such as eclampsia, pre-existing hypertensive disorder with superimposed proteinuria and gestational hypertension (induced by pregnancy) with significant proteinuria increase the length of hospital stay. This study enabled the construction of distinct criticality level profiles based on the combination of age groups and the main comorbidities, which were directly related to the length of hospital stay.

Accuracy of Medicaid Payer Coding in Hospital Patient Discharge Data

Medical Care ◽  
2005 ◽  
Vol 43 (6) ◽  
pp. 586-591 ◽  
Author(s):  
Arpita Chattopadhyay ◽  
Andrew B. Bindman
Keyword(s):  
Patient Discharge ◽  
Hospital Patient ◽  
Discharge Data
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